By Patrice Ierardi, DMD, BeneCare Dental Director
On average cost trends in medical and dental care services have consistently outpaced inflation.[i] Utilization is one of the primary drivers, but reducing utilization strictly for cost-control reasons is not a long-term strategy towards achieving improved oral health outcomes.
The key to making cost control a result of improved oral health outcomes is to provide patients access to proper care by well-informed practitioners. The three keys are:
- Adopting peer-reviewed standards of care.
- Analyzing treatment patterns to identity outliers.
- Promoting patient education.
CREATING A SENTINEL EFFECT.
By adopting a review process that relies on practitioner-accepted standards of care rather than a computer algorithm, there is a mechanism to help ensure patients are receiving proper care. This is accomplished by having dental peers review treatments on a prepayment basis, creating a sentinel effect which helps to:
- Ensure each covered procedure will have a satisfactory prognosis.
- Eliminate incomplete, inappropriate, or unnecessary sequencing of treatment.
- Inform patients of coverage and their financial obligations.
ANALYSIS OF UTILIZATION PATTERNS.
The statistical monitoring of practitioners’ utilization patterns can also provide valuable insight into care-delivery behaviors. Predictive analytics look at practitioners’ utilization and claims data to analyze care-delivery patterns compared to population norms. These and other factors are considered in the analysis:
- Patient demographics information.
- Type of practice and year of practitioner’s licensure.
- Socioeconomics of the practice location.
This statistical analysis helps identify potential under- or over-utilization by setting benchmarks for treatment patterns consistent with the patient population’s dental health needs and the prevailing community standard of care.
As a dental consultant, educator, and former private practice dentist, I am an advocate for arming patients with the information to make better-informed decisions. I stress this to my students and practiced it with my patients. Don’t let the white coat stop anyone from asking for more information.
THE BOTTOM LINE IS… THE BOTTOM LINE.
These three factors — standards of care, predictive analytics, and patient education — are keys to helping maximize your dental dollar and helping to make cost control an outcome of providing access to proper care.
With proper access, the improvement in oral health status leads to cost containment as an outcome. As always, prevention is less expensive than treatment and the proper model needs to create an incentive to move the population to better oral health, leading to cost savings.
NEED MORE INFORMATION?
Plan sponsors should contact their benefit consultant for additional details and a quote or you may contact BeneCare Dental Plans directly using an online request or by calling 800.445.6665. Benefit Consultants may also call 800.445.6665 or submit an online request.